Provider Demographics
NPI:1851759856
Name:HEMINGWAY, SHAUNTA (CADC III, MAC, LPC)
Entity Type:Individual
Prefix:DR
First Name:SHAUNTA
Middle Name:
Last Name:HEMINGWAY
Suffix:
Gender:F
Credentials:CADC III, MAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-3513
Mailing Address - Country:US
Mailing Address - Phone:541-972-2802
Mailing Address - Fax:541-972-4001
Practice Address - Street 1:1170 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3513
Practice Address - Country:US
Practice Address - Phone:541-972-2802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OR6278101YM0800X
15-08-22U101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR50070861Medicaid
OR500708761Medicaid